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Turned away in a crisis

Wednesday 10th February 2016

New Zealand's suicide rate spiked again last year and those on the frontline - parents, friends and health workers - say more help is needed to prevent deaths.

Photo: 123rf

Warren Botica, 19, “wasn’t into a hell of a lot”, says his mum, Lynda, but boy did he love cars.

Some people colour in to relax; Warren changed spark plugs. His boy-racer therapy led him to owning four cars, despite never getting a license.

“If you’ve got a car, someone will always drive for you,” he reckoned.

Warren started seeing a community mental health counsellor in July 2012, after his girlfriend broke up with him. The break-up had triggered a sense of abandonment he’d felt when his grandfather died three years earlier. When his counsellor went overseas for eight weeks he was transferred to the care of Auckland’s St Lukes Community Mental Health team.

He spent the following month trying to kill himself. Every time Lynda rang the crisis team she says she was told to care for him through the night and the mental health team would look into it in the morning. She claims many mornings passed and no adequate help came.

Usually a suicide attempt will get you a stay in a hospital’s psychiatric unit; even voicing intent can have the same result. Warren attempted for more than a month, claims Lynda, on some occasions presenting at Auckland Hospital’s emergency department because he’d talked about the idea of ending his life - or made attempts - but would be sent home as there were no signs of imminent risk.

He said: ‘See mum, no one cares. I feel sorry for you because you’re the only one that cares. You should just let me leave’.​

“Warren wanted to go to respite care for at least three days to give me a break and himself a rest,” Lynda says. “I rung them and said: ‘Look, this kid has never, ever asked for anything like this ‘cause he’s not that type of boy’.”

On August 13, a crisis assessment team tried to find a respite unit for Warren after he made suicide attempts the night before but there weren’t enough beds. Instead they made a home visit later that day.

“He said: ‘See mum, no one cares. I feel sorry for you because you’re the only one that cares. You should just let me leave’.”

By this point Lynda was in a state of constant vigilance to stop her only son killing himself. Close friends tried to remind him of the effect his death would have on others.

“I got the impression that because I was a mum that cared, they thought I was doing the job for them - that he was joking and wouldn’t do it. Auckland Hospital said there was nowhere they could put him and the best place was at home.”

The fourth time Warren presented at the emergency department, she claims a suicide liaison worker got angry.

“The guy said ‘I’ve said to you before, you don’t come here, you ring St Lukes Mental Health. This is how it is, you don’t come to hospital every time you are suicidal’,” says Lynda.

“But we’d been ringing St Lukes for more than a month. They never helped. After that, I think he just had enough.”

On 17 August, Warren asked Lynda to go to the supermarket to get him some chocolate, leaving him under the supervision of his grandmother. When she arrived home he was dead.

Lynda says: “The mental health team rang on Monday to ask how Warren had gone over the weekend and mum answered ‘well he didn’t, he took his life’.”

Auckland District Health Board has since apologised in a letter for their substandard care, she says.

“I don’t think they’ve learnt, though, or our suicide rate wouldn’t be so high. I don’t think help is out there for these kids.”

UPDATE 11/2/2016 - Auckland DHB has responded to a request for comment on Warren Botica's case with this statement:

Coroner CJ Devonport’s formal finding has, under section 71 of the Coroner’s Act, placed a restriction on making public any particulars of the death of Warren Botica in 2012.

However, while respecting the Coroner’s order, we can confirm the findings on Warren Botica’s death in which there is a detailed record of the clinical interactions Auckland DHB’s Mental Health and Addictions and Auckland City Hospital (ACH) Emergency Department services had with Mr Botica. These were in person and by telephone at his home, in the community and at ACH. That record contradicts the reported account about Mr Botica’s interactions with Auckland DHB’s community mental health and ACH emergency department.

Warren Botica’s mother was sent two letters from Auckland DHB in early 2013 in response to her complaint about an interaction between her son and a staff member when her son presented to ACH’s Emergency Department. The first, dated 30 January, contained an apology to Mrs Botica that a service interaction with her son had caused her distress. It also noted that the clinical advice given to Warren had succeeded in facilitating Warren’s continuing engagement with the community mental health team. This was followed by another letter on 22 April, after Mrs Botica wrote expressing dissatisfaction with this 30 January response. In that second letter we expressed regret at Mrs Botica’s loss and apologised that Mrs Botica felt the interaction to be disrespectful.

Auckland DHB would like to again express its condolences to Mrs Botica and Warren Botica’s wider family.  

***

In researching this article, requests for information on how many New Zealanders who died by suicide last year had been in touch with mental health services were sent to all 20 DHBs.

So far 14 have provided the data requested.

Of the 569 suicides last year from June 2014 - May 2015, 449 were in the DHB regions that provided information.

Of the 449, 142 were under the care of mental health services.

Three died inside mental health units, one committed suicide when they escaped a mental health unit and another committed suicide after unescorted leave from a unit.

The Wireless will update these statistics as more data is made available.

***

Nearly four years after Warren’s death, New Zealand’s mental health system is reaching breaking point according to a number of nurses, doctors, politicians and patients spoken to by The Wireless.

Suicide accounts for a third of all deaths in those aged 15-24 and New Zealand’s youth suicide rate is the highest in the OECD - double that of Australia - according to the Office of the Director of Mental Health’s most recent annual report.

“I’d be surprised if the mental health system hasn’t completely collapsed on itself by the end of 2016,” says one source who works in the sector but did not want to be named for fear of recrimination.

Meanwhile, the number of people presenting to emergency departments due to mental health issues has increased by more than 60 percent since 2012.

The Labour Party obtained figures covering nine of the 20 DHBs - including Auckland, Bay of Plenty, and Southern - that showed 1300 people with mental health problems went to emergency departments in June last year, compared with 800 for the same month in 2012.

The number of dedicated mental health beds for the general public has decreased by 175 over five years, according to figures obtained by Labour (although Counties Manukau is introducing 24 extra beds this year).

This drop has come even as more adults are being admitted to inpatient units.

***

Not so long ago, New Zealand was considered a leader in mental health rights.

Starting in the 1970s there was a worldwide movement to care for mental health issues outside of institutions. Two decades later, nearly all psychiatric hospitals had closed and patients were moved to community care, introducing problems they, and we as a society, are still recovering from. Released with minimal support, many of the patients didn’t have families or networks of their own and ended up on the streets.

This led to the 1995-1996 Mason Inquiry - an investigation into mental health services in New Zealand. The inquiry, named after chairperson Judge Ken Mason, resulted in major changes such as the introduction of a policy to protect mental health funding.

It also led to the setup of the Mental Health Commission, established in 1996 to advise the Government on the needs of those experiencing mental illness, encourage research and advocate for improvements and appropriate services for Maori.

The Commission was scrapped in 2012, with a Mental Health and Addiction Commissioner role devolved to the Human Rights Commission instead.

The final legacy of the Commission was Blueprint II: Improving mental health and wellbeing for all New Zealanders, a guide to mental health service delivery until 2022.

***

For many struggling with mental health issues the biggest barrier is getting help because they are not actively suicidal.

Natasha, 25, became overwhelmed by anxiety when she was studying vet-nursing in Palmerston North and had to pull out.

“I started feeling like I was a failure in life and my depression became much worse.”

In July she was referred by her GP to a community mental health team. After the assessment she was told she fell into the “grey zone”. Community mental health centres offer free counselling and psychiatric appointments, but their capacity is limited

“I was too high needs for primary care but not nuts enough to be under secondary level care,” she says.

Six months later she tried “extremely hard” to commit suicide.

My mum would drive up to see me every day. The nurses catered to her concerns and never made anything seem like too much.

“I was under huge financial burden, I’d had to put my cat - my lifeline - down a few days prior and was told by my best friend I was too much to handle and she was moving out.”

After her attempt she was hospitalised in a psychiatric unit for 13 days.

“The nurses on the ward were absolutely wonderful,” she says.

“My mum would drive up to see me every day. The nurses catered to her concerns and never made anything seem like too much.”

Nevertheless, Natasha considers herself lucky to be alive and says more work needs to be done on preventing people from getting to a point where they consider suicide.

“Both mum and I agree that I probably wouldn’t have tried to commit suicide had I been accepted under community care those few months earlier.”

***

Claire* from Dunedin presented to the Southern DHB’s emergency psychiatric service multiple times leading up to her suicide attempt last year only to be turned away because there was no room, she says.

“At one stage they were trying to kick someone out of the psych ward for me to be admitted but couldn’t justify risking one life to save another.”

On a Friday night she told emergency nurses she was planning to kill herself but the nurse told Claire she was “wasting her time” and sent her home to be watched over by her flatmates.

She was found unconscious in her room, nearly two hours later and spent the next three days in an intensive care unit.

Southern DHB medical director for mental health Brad Strong says the emergency psychiatric service follows an initial triage screening process to determine the level of urgency before a full mental state examination is conducted.

"In the unlikely event that we did not have any inpatient beds available, we would work with the presenting person to ensure that a safety plan was in place in the interim," he says.

***

Mental health nurses spoken to for this story say they are over-worked, facing a continued increase in patients, lack support and see staff quit frequently due to ongoing frustration with limited resources.

None wanted to be named for job security reasons. One said workers in the acute psychiatric hospital she is based at are banned from talking to media.

“Even when MPs have come through we aren’t allowed alone time with them in case we say something embarrassing.”

She has been working in the profession for five years and says the focus on community-based care since the 1990s came at the expense of treating more severe mental illnesses appropriately.

“Although our facility is for acute patients we have had people with us for as long as a year because there is simply nowhere else. The families are exhausted by it. It’s horrible for us and even more horrible for the patients.

“People talk about places like Kingseat [Hospital] and denounce them for being institutions … Maybe the care there was heavy-handed or wrong in parts but what’s happening now is also very wrong - expecting the families and society to take an enormous burden but using the language of ‘empowering’ people?

“It’s crap - it’s all about money and shifting cost.”

Mental health nurses are increasingly working double shifts, she says.

“There just aren’t enough people coming on the next shift and many of us feel we should stay to keep out facility safe. Eight hours, though, is very hard - imagine 16.

Another psychiatric nurse spoken to works on a crisis team that deals with referrals and brings people into compulsory treatment under the Mental Health Act.

She says the unit she works at often holds more patients than there are beds.

The lack of beds is a common problem among inpatient psychiatric units, with accounts of patients being moved elsewhere or even sleeping in hallways. Or, in Warren’s case, not getting any bed at all.

There just aren’t enough people coming on the next shift and many of us feel we should stay to keep out facility safe. Eight hours, though, is very hard - imagine 16.

“When there are more service users than beds we send the least at-risk patients home on leave. They are still technically inpatients but at home until coming back to the ward to be reviewed by the psychiatrist and discharged,” the nurse says.

They also sometimes put patients in the whanau room - sometimes two sharing a room - and others in the unlocked seclusion rooms.

“This becomes an issue needing to juggle patients when someone needs to be secluded or there are pending admissions. We also have to transfer low-risk patients to other medical wards as over-spill.”

***

While Health Minister Jonathan Coleman says funding for mental health and addiction services has increased by $300 million since 2008, Labour mental health spokesman Dr David Clark says this isn’t enough to cover inflation and increasing demands on services.

Clark estimates DHB services in general have been underfunded by $1.7 billion in the past six years.

WATCH Labour MP David Clark on funding for mental health services:

Despite requesting interviews with the Minister of Health since October last year The Wireless were told he was too busy to answer questions in person or via phone call.

Instead, a spokeswoman emailed through a statement after being sent written questions about access to mental health crisis services. The statement says:

“The Ministry is working with police to try to understand why people in distress call 111 rather than, or in addition to, other services such as their DHB crisis line.

“Those assessed as being at high risk of suicide are responded to immediately” and “the time between an individual’s request for assistance and follow-up care will depend on the needs of that person and their level of risk”.

An interview with the Director of Mental Health, John Crawshaw, was also sought in October but his spokeswoman declined the request, saying most questions regarding long wait times and under-resourcing were better directed at individual DHBs.

It is worth noting the Government does have a detailed suicide prevention plan - however the majority of those interviewed say most suggestions haven’t been implemented.

***

At an old wine-making plant in West Auckland, Coolio’s Gangster’s Paradise is booming and teens are spraying abandoned concrete walls. A fleet of cars are on display as muscular bogans proudly check one another’s paint jobs. A couple of metres away are slightly worn down carnival rides, a live band, a sausage sizzle. Amidst multiple stalls bearing messages of hope sits Warren’s mum.

Jazz Sutton organises Carnival for a Cause every year in memory of Warren. She was his friend.

“It’s a real sign we’re not fully on top of the game as we could be with suicide prevention in New Zealand,” she says talking about Warren’s death.

Last year, she says a friend’s cousin turned up at the emergency room with visible self-harm marks, pleading for help. Like Warren, she was also turned away and committed suicide not long after.

Sutton also attempted suicide - nine years ago, at age 19.

She remains hopeful for future mental health care action and says that despite the horror stories people need to remain positive - if they can’t get help the first time, they should keep trying until they do, she says.

WATCH Jazz Sutton talk about getting help and Warren Botica:

And she’s working on a proposal for a respite centre in the Waitemata District Health Board that would be a 24/7 suicide watch facility as well as an ongoing recovery and rehabilitation house.

“The centre would help provide training for what I call life skills: work experience, budgeting, hobbies, cooking, parenting courses - so the person at risk isn’t just watched over until they feel a bit better, they are encouraged and helped to work on a life they feel is worth living.”

Family, friends, a supportive psychologist and a moment in the ambulance ride to the hospital helped her get through her own suicide attempt.

“On the way to the hospital to be seen for x-rays and stuff the orderly decided to take me outside for a cigarette break.

“He just spoke to me really candidly, like a friend he’d always had, and really reiterated how awesome it was that I was here, in that very moment, doing nothing. Just the fact I was there. The words have never gone away for me and his face is in my memory every day.

“People think ‘how can one person make a difference?’ But that one orderly - who hadn’t necessarily had any suicide prevention training - just having his support and knowing someone cared was enough to give me that spark of hope to keep going.”

***

Sutton isn’t the only one to start a support group in the wake of a loved one’s suicide. A growing number of grassroots bereavement groups have recently emerged as people left behind claim there is a lack of support for them after a suicide.

One of those is Life Matters Suicide Prevention Trust, which Dunedin mother Corinda Taylor started after the suicide of her 20-year-old son, Ross, in 2013.

She can’t say much about Ross’ final moments and care as the Southern DHB are being investigated by the Health and Disability Commissioner.

She says her son was a kind, gentle and caring person that got unwell. “He had a good sense of humour and was smart. He had huge potential to contribute in a positive way to society. He was very much loved by his family and our hearts are broken.” 

As a result of her experience, Taylor has spent the past year trying to stop others from going through what he did. She says she’s  often bombarded with people trying to get access to mental health services.

“They don’t want to be dismissed at 4am, told to go home and have a cup of tea or a bath. It’s just not good enough - if they managed to get themselves to the emergency department they need to be listened to.”

WATCH Corinda Taylor give her views on the mental health system:

She says the Southern DHB’s record-keeping for mental health is hand-written and not interfaced within the electronic general health system.

As the mental health ward in Dunedin (Wakari) is off-site from the emergency department it means workers have to drive to where the file is kept. This leads to an array of issues, she says, such as a hospitalisation for self-harm being dismissed early because staff aren’t aware of a patient’s mental health background.

Southern DHB chief executive Carole Heatly says mental health patient information is recorded both electronically and in paper record.

I see my son in all these people. I saw my son asking for help. I see these people asking for help and it breaks my heart that they are ignored.​

“Information recorded and stored electronically includes items such as demographics and laboratory results. Items such as patient progress notes including patient plans and correspondence are held in paper form.”

Some changes that would improve the system, according to Taylor, are: a team of psychiatrists on during the night - not just nurses, electronic mental health records with the most important issues highlighted, and more family and whanau involvement.

“It is heartbreaking to go in there and see your loved ones so unwell and to feel so unsupported by the system,” Taylor says.

Running a Facebook page dedicated to suicide prevention means Taylor frequently has to ring crisis teams about people threatening to kill themselves. It highlights just how desperate people are, she says, in that they are coming to a stranger because they can’t get help.

“I see my son in all these people. I saw my son asking for help. I see these people asking for help and it breaks my heart that they are ignored.

“I often hear people say ‘I’m not bad enough to go to the emergency department, but I need to get help’ and that’s the biggest problem. That’s preventative. Those people need help before they escalate to the point where they are suicidal.”

*Some names have been changed to protect identities

NEED HELP?

If you need to talk to someone about your own mental health, try these helplines. If it is an emergency, call 111.

Lifeline - 0800 543 354

Depression Helpline - 0800 111 757

Healthline - 0800 611 116

Samaritans - 0800 726 666

Suicide Crisis Helpline (aimed at those in distress, or those who are concerned about the wellbeing of someone else) - 0508 828 865 (0508 TAUTOKO)

Youthline - 0800 376 633, free text 234 or email talk@youthline.co.nz

This content was produced with funding support from NZ On Air.



Join the discussion »

“Mental health needs an enormous reform towards primarily a ground-up, compulsory, at-school-based, holistic model- URGENTLY!

I am SO extremely sorry for those in this article. It's so hard to know what to do in those circumstances. Our country needs to demand change: such enormous problems indicate that THE SYSTEM DOESN'T WORK!

The methods we use today are to ignore the problem, resulting in an "ambulance at the bottom of the cliff" scenario: suicide, power abuses, toxic psychiatric drugs, homelessness, addiction, mass incarceration, and everything else! Western society is "one big 'mental health' problem"!

The only way I know of that could POSSIBLY have a positive effect on all of the above is PREVENTION: A comprehensive education, at the school level.

Ultimately, we teach children about basically everything EXCEPT THAT WHICH HAS MOST IMPACT ON DETERMINING THE QUALITY OF THEIR LIFE: their mind. In the past we had the excuse that we didn't know enough about human well-being aka "mental health" to do this - but this is not the case in 2016! A truly twenty-first century education system towards a truly twenty-first century society demands it!” — alosius


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